ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Withholding Primary Pneumocystis Pneumonia Prophylaxis in Virologically Suppressed Patients With Human Immunodeficiency Virus: An Emulation of a Pragmatic Trial in COHERE.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 21 citations in OpenAlex.
- Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials: A Systematic Review.JAMA network open · 2023Pooled it
- Comparative Effectiveness Analysis of Lumpectomy and Mastectomy for Elderly Female Breast Cancer Patients: A Deep Learning-based Big Data Analysis.The Yale journal of biology and medicine · 2023Trial
- Design and Implementation of Observational Studies Emulating a Target Trial.JAMA network open · 2026Article
- Pneumocystis Pneumonia-Is it Still a Threat Among People With Human Immunodeficiency Virus (HIV)? A Danish HIV Cohort Study.Open forum infectious diseases · 2025Article
- Machine learning-based prediction of mortality risk in AIDS patients with comorbid common AIDS-related diseases or symptoms.Frontiers in public health · 2025Article
- Application of the estimand framework for an emulated trial using reference based multiple imputation to investigate informative censoring.BMC medical research methodology · 2024Article
- Meeting the Therapeutic Challenges of Emergent and Rare Invasive Fungal Diseases Through Novel Clinical Trial Designs.Open forum infectious diseases · 2024Review
- Review
- Implementation of the trial emulation approach in medical research: a scoping review.BMC medical research methodology · 2023Article
- Primary or secondary prevention of HIV-associated histoplasmosis during the early antiretrovirals for all era.PLoS neglected tropical diseases · 2023Article
- The Pathogenesis and Diagnosis ofJournal of fungi (Basel, Switzerland) · 2022Review
- No need for secondary Pneumocystis jirovecii pneumonia prophylaxis in adult people living with HIV from Europe on ART with suppressed viraemia and a CD4 cell count greater than 100 cells/µL.Journal of the International AIDS Society · 2021Observational
Corrections and comments
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Authors and funding
20 authors at 20 institutions in 11 countries.
Funding
Abstract
backgroundUsing data from the COHERE collaboration, we investigated whether primary prophylaxis for pneumocystis pneumonia (PcP) might be withheld in all patients on antiretroviral therapy (ART) with suppressed plasma human immunodeficiency virus (HIV) RNA (≤400 copies/mL), irrespective of CD4 count.
methodsWe implemented an established causal inference approach whereby observational data are used to emulate a randomized trial. Patients taking PcP prophylaxis were eligible for the emulated trial if their CD4 count was ≤200 cells/µL in line with existing recommendations. We compared the following 2 strategies for stopping prophylaxis: (1) when CD4 count was >200 cells/µL for >3 months or (2) when the patient was virologically suppressed (2 consecutive HIV RNA ≤400 copies/mL). Patients were artificially censored if they did not comply with these stopping rules. We estimated the risk of primary PcP in patients on ART, using the hazard ratio (HR) to compare the stopping strategies by fitting a pooled logistic model, including inverse probability weights to adjust for the selection bias introduced by the artificial censoring.
resultsA total of 4813 patients (10 324 person-years) complied with eligibility conditions for the emulated trial. With primary PcP diagnosis as an endpoint, the adjusted HR (aHR) indicated a slightly lower, but not statistically significant, different risk for the strategy based on viral suppression alone compared with the existing guidelines (aHR, .8; 95% confidence interval, .6-1.1; P = .2).
conclusionsThis study suggests that primary PcP prophylaxis might be safely withheld in confirmed virologically suppressed patients on ART, regardless of their CD4 count.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.